Barriers and facilitators to genomic testing uptake and cancer clinical trial enrollment in historically underrepresented patient populations - Clinician and research staff perceptions

Background

An increasing proportion of cancer clinical trials involve targeted therapies that require genomic testing to determine patient eligibility. Underrepresented minority (URM) patients (including Black, Latinx, Asian, Indigenous, older adult (age 70+), low socioeconomic status, and limited-English proficient) may lack access to cancer clinical trials in part because of hesitancy to consent to genomic testing; herein we analyze clinician and research staff perspectives on the barriers and facilitators to consent.

Methods

Interviews were conducted via Zoom from 7/7/2021 – 8/4/2021 with eight medical oncologists and three clinical research coordinators at an academic oncology center and its community-based satellites. An interview guide prompted participants on their experiences enrolling URM patients in genomic testing and cancer clinical trials. Analysis involved an iterative coding process and comprehensive thematic analysis to identify predominant patterns and themes.

Results

Six primary barriers for URM to genomic testing and clinical trials were identified: low patient levels of medical literacy, logistical accessibility (i.e., transportation, childcare, and time off work), insurance coverage, language barriers, patients seeking care at local healthcare centers with fewer resources to provide clinical trials, and a lack of community awareness contributing to a mistrust of clinical trials. The following support systems were identified to increase genomic testing and clinical trial enrollment: logistical, financial, peer, and language supports for patients; community outreach and education around clinical trials; a resource sheet listing clinical trial options for patients; universal genomic testing; and increased diversity among social work and research staff.

Conclusion

Clinicians and research staff overwhelmingly cited time constraints as a limitation in addressing the many barriers to URM genomic testing uptake and clinical trial enrollment. This analysis describes a need for personalized, substantial support systems to assist patients in navigating informational and situational gaps in care. Interviews analyzing patient perspectives have been completed, with thematic analyses forthcoming.